Abstract 18506: Relief of Myocardial Edema in Advanced Decompensated Heart Failure is Associated with Improved Left Ventricular Systolic and Diastolic Function
Introduction: Cardiac magnetic resonance (CMR) imaging with quantitative T2-mapping allows identi[[Unable to Display Character: ﬁ]]cation of myocardial edema, improving risk-stratification in acute coronary syndromes and myocarditis.
Hypothesis: Global myocardial edema contributes to left ventricular (LV) dysfunction in advanced decompensated heart failure (ADHF).
Methods: CMR with quantitative T2-mapping was performed in consecutive ADHF patients (n=17) undergoing right heart catheterization for worsening dyspnea and volume overload. Patients received vasodilators and diuretics to achieve pulmonary capillary wedge pressure (PCWP) ≤18 mmHg and central venous pressure (CVP) ≤10 mmHg, while maintaining mean arterial pressure ≥65 mmHg. After reaching hemodynamic targets, the pulmonary arterial catheter was removed and CMR imaging repeated. Changes in LV T2-values, hemodynamics, and CMR volumetric measurements were compared.
Results: Study patients (64±11 years, male 88%, LV ejection fraction 23±8%, ischemic cardiomyopathy 50%) received decongestive treatment during 5±2 days. PCWP and CVP decreased from 25±7 to 17±4 mmHg and 13±6 to 7±3 mmHg, respectively (p<0.001 for both), while cardiac index increased from 2.14±0.60 to 2.58±0.49 L/min/m2 (p=0.012). LV T2-values dropped consistently from 59.6±4.9 ms to 56.3±5.2 ms after decongestion (p=0.002; Figure). Decreasing LV T2-values correlated well to both decreasing PCWP (r=0.75; p=0.001) and increasing cardiac index (r=0.58; p=0.023). Although LV end-diastolic volume index (142±31 to 135±34 mL/m2; p=0.033) and end-systolic volume index (110±29 to 99±33 mL/m2; p=0.001) both decreased significantly, the extent of these changes were not correlated to changing T2-values (r=0 and 0.11, respectively; p=ns).
Conclusions: Global LV myocardial edema is observed in ADHF and reversible with successful decongestive therapy. Relief of myocardial edema strongly correlates with improvements in systolic and diastolic function.
Author Disclosures: F.H. Verbrugge: None. E. Willems: None. P.B. Bertrand: None. E. Gielen: None. W. Mullens: None. S. Giri: Employment; Significant; Siemens Healthcare. S.V. Raman: Other Research Support; Significant; Siemens Healthcare. D. Verhaert: None.
- © 2014 by American Heart Association, Inc.